Written by Elizabeth Steels, Ph.D.
The prerequisites for developing benign prostate
hypertrophy (BPH) are the presence of testes
and age. It is one of the most frequently
occurring diseases in men over 60 years of age.
According to the National Institute of Health
(NIH), BPH affects more than 50 percent of men
over the age of 60 and as many as 90 percent of
men over the age of 70. This translates to a staggering 4.5 million
visits to a physician for BPH in the United States in 2000.¹
What are the symptoms?
In the initial stages, a patient may experience increased urinary
frequency during the day, nocturia (getting up at night to go to
the toilet) and the sensations of not being able to empty completely.
As the condition becomes more advanced, there is an
increase in the obstructive symptoms characterized by the following:
weak urine stream, difficulty starting urination, straining
to urinate, stopping and starting again while urinating, dribbling
at the end of urination, urgency, and pain on urination. If
the BPH symptoms are severe, it may result in the inability to
urinate. This can cause severe pain and discomfort. In addition,
if urine is retained in the bladder for long periods of time, this
can lead to urinary tract infections, bladder or kidney damage,
or bladder stones.³
What is the primary risk factor?
It appears that age itself is the primary risk factor for developing
symptoms associated with BPH.
Is there a link between hormonal changes during aging and
benign prostate hypertrophy?
The exact cause of BPH is unclear, although researchers believe
it may be caused by hormonal changes that occur during
the aging process.
- Decreased testosterone levels: One theory is that as a man ages, the amount of testosterone in his blood decreases, leaving a higher proportion of estrogen in his blood. The disproportion of estrogen may contribute to cell growth within the prostate gland.
- Increased levels of dihydrotestosterone (DHT): Another possible theory is that as a man ages there is a hormonal change involving the accumulation of DHT, a by-product of testosterone in the body. If levels of DHT accumulate in the prostate,
- overgrowth of cells in the prostate can occur.³
What are the possible treatments?
Treatment for BPH depends on the severity of symptoms. Medications are the most common way to control mild to moderate symptoms of BPH. Watchful waiting, also known as observation,
expectant therapy or deferred therapy, is often the preferred approach
for men with mild symptoms who aren’t bothered by
The most commonly used medications are alpha-adrenergic
blocking agents which work by relaxing the smooth muscle tissue.
Since there is a large number of alpha-adrenergic receptors
in the bladder, the bladder neck and prostate gland, they cause
relaxation and reduced tone, which then allows urinary flow. Although
these drugs have been found to be effective, patients
may experience side effects including headache, dizziness, low
blood pressure, fatigue, weakness, and difficulty breathing.
These are due to the fact the drug works on all smooth muscle
tissue in the body, not just the prostate. The long-term risks
and benefits have not been studied.&sup4;
The other common drug treatment is enzyme (5-alpha
reductase) inhibitors that work directly on the endocrine system.
They prevent the conversion of testosterone to the hormone dihydrotestosterone
(DHT) and as a result reduces the size of the
prostate itself. However, while studies have shown a decrease
in symptoms it does not correlate with urinary flow rate and
volume. In many cases, a treatment period of six months is
necessary to see if the therapy is going to work. The side effects
include reduced libido, impotence, breast tenderness and enlargement,
and reduced sperm count. Again, these effects are
due to the fact the drug may reduce the total testosterone in
the body and the effects are not restricted to the prostate gland.
The long-term risks and benefits have not been studied.
Most doctors recommend removal of the enlarged part of the
prostate as the best long-term solution for patients with BPH.
With surgery for BPH, only the enlarged tissue that is pressing
against the urethra is removed; the rest of the inside tissue and
the outside capsule are left intact. Surgery usually relieves the
obstruction and incomplete emptying caused by BPH.1 Surgery
used to be the most common way to treat BPH. Today, its use is
declining because of new medications and minimally invasive
treatments. Surgery is usually used when non-surgical treatments
fail or if there are BPH complications.²
The principle goal of BPH treatment is to reduce excessive
cell growth by inhibiting the conversion of testosterone into
the more potent hormone dihydrotestosterone (DHT) and so
preventing estrogen from attaching to receptors in prostate
Some supplements are intended to reduce symptoms while
others will provide nutritional support. The combination of glycine,
alanine, and glutamic acid can reduce urinary urgency,
urinary frequency, and delayed micturition (initiation of flow).
Beta-sitosterol may also help reduce symptoms of BPH. Betasitosterol
also lowers cholesterol, which is important since high
cholesterol levels can contribute to prostate hypertrophy. Flaxseed
oil is a good source of the essential fatty acid (EFA) alphalinolenic
acid (an omega-3 fatty acid). It is well-known that zinc
is an important mineral for male health. Why? It may be related
to the fact that zinc inhibits 5 alpha reductase and therefore
lowers DHT production.
The most well studied herb is saw palmetto (Serenoa serrulata).
Saw palmetto is a 5-alpha reductase inhibitor that inhibits
the conversion of testosterone to DHT in the prostate, has an
antiestrogenic effect, and helps improve all symptoms of BPH.
Both pygeum (Pygeum africanum) and stinging nettles (Urtica
dioica) may also reduce BPH symptoms although research is
Latest research— UrologicPros
One of the most recent exciting breakthroughs in this area has
been the development of a unique herbal and mineral preparation,
UrologicPros™, which has been clinically proven to be effective
in reducing the urinary symptoms associated with BPH.
UrologicPros contains a patented formulation of herb ingredients,
crateva and horsetail, which has been shown to be effective
in treating the symptoms of overactive bladder in men and
women with urinary incontinence. In this formulation, it has
been combined with saw palmetto, zinc and selenium, which
support prostate health.
In the most recent study, 33 men were asked to take UrologicPros
(as an oral supplement) each day for a period of three
months. Symptoms were assessed using a diary of urinary frequency
(day and night) and the International Prostate Symptom
There was a significant gradual reduction in daytime urinary
frequency over the three months, for those with moderate and
severe symptoms. There was also a significant reduction in episodes
of nocturia over the three months.
There was an overall 40 percent reduction in symptoms over
the three months. The median reduction (of individual results)
was 45 percent with a range from (0–81 percent improvement).
The greatest improvement was seen relating to nocturia, and
urinary flow (particularly the symptom “difficulty emptying bladder”).
The positive effect of the treatment on nocturia was seen
within the first month, whereas the urinary flow symptoms improved
most significantly after two months of treatment. There
was also a significant improvement in quality of life reported
as well. At completion of the study, 29 of the 33 subjects (88
percent) wanted to continue with treatment.
|Figure 1: Average daytime urination frequency after treatment
|Figure 2: Average episodes of nocturia after treatment with
The inclusion of whole, fresh, unrefined, and unprocessed
foods including fruits, vegetables, whole grains, soy, beans,
seeds, nuts, olive oil, and cold-water fish (salmon, tuna, sardines,
halibut, and mackerel) may help. It is important to remember
that eating organic food helps reduce exposure to
hormones, pesticides, and herbicides (which affect testosterone
and estrogen balance). Optimal hormonal balance will occur in
the absence of refined sugar and flour, dairy products, refined
foods, fried foods, junk foods, and hydrogenated oils. There will
be less stress on the bladder system itself if the amount of alcohol
(particularly beer), and caffeine in the diet is reduced.
In summary, at present we have a limited understanding
of the pathology underlying the symptoms associated with an
enlarged prostate as men age. There are no specific pharmacological
medications specific for the prostate (or drugs that do
not have unwanted side effects in the body). Based on its current
success rate, surgery should always be considered a last
option when all other treatments have failed. However, there
is increasing research directed at the role for individual and
combined nutraceuticals in the management of urinary tract
problems including BPH. Therefore, natural treatments should
be considered as the first line of defense on the treatment of
benign prostate hypertrophy.
Elizabeth Steels, Ph.D. is the research director for Applied Science
and Nutrition, an Australian based research organization. Elizabeth is a clinical nutritionist with over 15 years in clinical research, natural health and education.
- 1. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, NIH Publication No. 04–3012, Prostate Enlargement. http//kidney.niddk.nih.gov/kudiseases/pubs/prostate enlargement/index.htm#gland#gland
- 2. Mayo Clinic. Enlarged prostate (BPH) guide. www.mayoclinic.com/health/enlarged-prostate-bph/BP99999/PAGE=BP00016
- 3. E Drug digest. Begin Prostate Hypertropy. www.drugdigest.org/DD/HC/Treatment/0,4047,550246,00.html&e=14911
- 4. Urology Channel. Prostate. www.urologychannel.com/prostate